Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome: five-year results from a large cohort study

doi:10.5847/wjem.j.1920-8642.2023.012

Abstract

Abstract:

BACKGROUND: To investigate the most appropriate dual antiplatelet therapy (DAPT) duration for patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) implantation in the largest cardiovascular center of China.

METHODS: We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013. Patients were divided into four groups based on DAPT duration: standard DAPT group (11-13 months, n=1,568) and prolonged DAPT groups (13-18 months [n=308], 18-24 months [n=2,125], and >24 months [n=1,186]). Baseline characteristics and 5-year clinical outcomes were recorded.

RESULTS: Baseline characteristics were similar across the four groups. Among the four groups, those with prolonged DAPT (18-24 months) had the lowest incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (14.1% vs. 11.7% vs. 9.6% vs. 24.2%, P<0.001), all-cause death (4.8% vs. 3.9% vs. 2.1% vs. 2.6%, P<0.001), cardiac death (3.1% vs. 2.6% vs. 1.4% vs. 1.9%, P=0.004), and myocardial infarction (MI) (3.8% vs. 4.2% vs. 2.5% vs. 5.8%, P<0.001). The incidence of bleeding was not different among the four groups (9.9% vs. 9.4% vs. 11.0% vs. 9.4%, P=0.449). Cox multivariable analysis showed that prolonged DAPT (18-24 months) was an independent protective factor for MACCEs (hazard ratio [HR] 0.802, 95% confidence interval [CI] 0.729-0.882, P<0.001), all-cause death (HR 0.660, 95% CI0.547-0.795, P<0.001), cardiac death (HR 0.663, 95% CI 0.526-0.835, P<0.001), MI (HR 0.796, 95% CI 0.662-0.957, P=0.015), and target vessel revascularization (HR 0.867, 95% CI 0.755-0.996, P=0.044). Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.

CONCLUSION: For patients with ACS after DES, appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.

Key words: Dual antiplatelet therapy, Acute coronary syndrome, Drug-eluting stent implantation

Jing-jing Xu, Si-da Jia, Lin Jiang, Ying Song, Pei Zhu, De-shan Yuan, Yi Yao, Xue-yan Zhao, Jian-xin Li, Yue-jin Yang, Shu-bin Qiao, Bo Xu, Run-lin Gao, Jin-qing Yuan. Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome: five-year results from a large cohort study[J]. World Journal of Emergency Medicine, 2023, 14(1): 25-30.

Figures/Tables 3

References 19

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Parameters	Standard DAPT	Prolonged DAPT			P-value
Parameters	11-13 months (n=1,568)	13-18 months (n=308)	18-24 months (n=2,125)	>24 months (n=1,186)	P-value
MACCEs	221 (14.1)	36 (11.7)	203 (9.6)^a	287 (24.2)^abc	<0.001^*
All-cause death	75 (4.8)	12 (3.9)	44 (2.1) ^a	31 (2.6)^a	<0.001^*
Cardiac death	48 (3.1)	8 (2.6)	29 (1.4) ^a	22 (1.9)	0.004^*
MI	59 (3.8)	13 (4.2)	54 (2.5)	65 (5.8)^ac	<0.001^*
TVR	96 (6.1)	17 (5.5)	104 (4.9)	213 (18.0)^abc	<0.001^*
Stroke	52 (3.3)	5 (1.6)	51 (2.4)	41 (3.5)	0.112
Bleeding	155 (9.9)	29 (9.4)	233 (11.0)	111 (9.4)	0.449